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To the Editor: The study by Dr Cohen and colleagues¹ reported that a high proportion of women who discontinued antidepressant treatment during pregnancy relapsed into major depression. One of the strategies evaluated was the discontinuation of the antidepressant during the first trimester and subsequent reintroduction. The authors concluded that interrupted therapy did not prevent depressive relapse as effectively as maintaining the antidepressant throughout pregnancy.

We question whether their observational data sufficiently support this conclusion. The women who restarted the antidepressant may have done so because of early symptoms of relapse. The authors do not describe the circumstances surrounding reintroduction, such as presence of symptoms at the time of reintroduction, the point in the pregnancy that patients resumed pharmacotherapy, and the duration between reintroduction and relapse. Without these data, and given that an observational study cannot truly attribute causality, it may be premature to remove reintroduction after the first trimester as . . . [Full Text of this Article]

Arthur Rifkin, MD
rifkin@lij.edu
Zucker Hillside Hospital
Glen Oaks, NY

William Rifkin, MD
Department of Medicine
Yale University School of Medicine
New Haven, Conn

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